Posterior Inferior Cerebellar Artery Stroke Due to a Severe Right Vertebral Artery Stenosis With a Left Cervical Internal Carotid Artery Dissection: What’s Next?

TL;DR

A 55-year-old man experienced a stroke caused by a combination of vertebral artery stenosis and carotid artery dissection, highlighting treatment challenges.

Contribution

This paper presents a rare clinical case combining vertebral artery stenosis and carotid artery dissection leading to stroke.

Findings

The patient had acute ischemia in the right posterior inferior cerebellar artery territory.

MRA and CT angiography confirmed right vertebral artery stenosis and left cervical internal carotid artery dissection.

The case illustrates the complexity of managing strokes caused by both stenosis and dissection.

Abstract

Guidelines for the treatment and management of ischemic strokes triggered by stenosis versus dissection are well established. However, the presence of both entities in the same patient, although rare, poses challenges for short- and long-term treatment. Here, we describe the case of a 55-year-old man who presented to the emergency department with a 72-hour history of headache, dizziness, unbalanced gait, nausea, and two episodes of vomiting. Stroke was initially suspected, but the computerized tomography (CT) scan showed no hemorrhage. His magnetic resonance imaging (MRI) showed right inferior cerebellar acute ischemia in the territory of the right posterior inferior cerebellar artery (PICA), with smaller foci of early acute infarcts in the bilateral inferior cerebellum. Furthermore, magnetic resonance angiography (MRA) and CT angiography revealed right vertebral artery stenosis and left cervical internal carotid artery dissection (ICAD). This clinical report describes a rare case of stroke secondary to vertebral artery stenosis with concomitant carotid artery dissection. The treatment course and evolution are presented.

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